Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study
Introduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to d...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-04-01
|
| Series: | Journal of Personalized Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4426/12/4/597 |
| _version_ | 1797410511046836224 |
|---|---|
| author | Jarosław Pawlik Lucyna Tomaszek Henryk Mazurek Wioletta Mędrzycka-Dąbrowska |
| author_facet | Jarosław Pawlik Lucyna Tomaszek Henryk Mazurek Wioletta Mędrzycka-Dąbrowska |
| author_sort | Jarosław Pawlik |
| collection | DOAJ |
| description | Introduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to determine risk factors and protective factors against VAP. Design: Mixed prospective and retrospective cohort study. Methods: The cohort involved 371 critically ill patients who received standard interventions to prevent VAP. Additionally, patients in the prospective cohort were provided with continuous automatic pressure control in tapered cuffs of endotracheal or tracheostomy tubes and continuous automatic subglottic secretion suction. Logistic regression was used to assess factors affecting VAP. Results: 52 (14%) patients developed VAP, and the incidence density of VAP per 1000 ventilator days was 9.7. The median days to onset of VAP was 7 [4; 13]. Early and late onset VAP was 6.2% and 7.8%, respectively. According to multivariable logistic regression analysis, tracheotomy (OR = 1.6; CI 95%: 1.1 to 2.31), multidrug-resistant bacteria isolated in the culture of lower respiratory secretions (OR = 2.73; Cl 95%: 1.83 to 4.07) and ICU length of stay >5 days (OR = 3.32; Cl 95%: 1.53 to 7.19) were positively correlated with VAP, while continuous control of cuff pressure and subglottic secretion suction used together were negatively correlated with VAP (OR = 0.61; Cl 95%: 0.43 to 0.87). Conclusions: Tracheotomy, multidrug-resistant bacteria, and ICU length of stay >5 days were independent risk factors of VAP, whereas continuous control of cuff pressure and subglottic secretion suction used together were protective factors against VAP. |
| first_indexed | 2024-03-09T04:31:06Z |
| format | Article |
| id | doaj.art-b08a18fb682f4c28b5767801e43f09bb |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T04:31:06Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-b08a18fb682f4c28b5767801e43f09bb2023-12-03T13:35:26ZengMDPI AGJournal of Personalized Medicine2075-44262022-04-0112459710.3390/jpm12040597Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort StudyJarosław Pawlik0Lucyna Tomaszek1Henryk Mazurek2Wioletta Mędrzycka-Dąbrowska3Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, PolandFaculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, PolandDepartment of Pneumonology and Cystic Fibrosis, National Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdroj, PolandDepartment of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, PolandIntroduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to determine risk factors and protective factors against VAP. Design: Mixed prospective and retrospective cohort study. Methods: The cohort involved 371 critically ill patients who received standard interventions to prevent VAP. Additionally, patients in the prospective cohort were provided with continuous automatic pressure control in tapered cuffs of endotracheal or tracheostomy tubes and continuous automatic subglottic secretion suction. Logistic regression was used to assess factors affecting VAP. Results: 52 (14%) patients developed VAP, and the incidence density of VAP per 1000 ventilator days was 9.7. The median days to onset of VAP was 7 [4; 13]. Early and late onset VAP was 6.2% and 7.8%, respectively. According to multivariable logistic regression analysis, tracheotomy (OR = 1.6; CI 95%: 1.1 to 2.31), multidrug-resistant bacteria isolated in the culture of lower respiratory secretions (OR = 2.73; Cl 95%: 1.83 to 4.07) and ICU length of stay >5 days (OR = 3.32; Cl 95%: 1.53 to 7.19) were positively correlated with VAP, while continuous control of cuff pressure and subglottic secretion suction used together were negatively correlated with VAP (OR = 0.61; Cl 95%: 0.43 to 0.87). Conclusions: Tracheotomy, multidrug-resistant bacteria, and ICU length of stay >5 days were independent risk factors of VAP, whereas continuous control of cuff pressure and subglottic secretion suction used together were protective factors against VAP.https://www.mdpi.com/2075-4426/12/4/597ventilator-associated pneumoniabundlerisk factorssubglottic secretion suctioncontinuous control pressure |
| spellingShingle | Jarosław Pawlik Lucyna Tomaszek Henryk Mazurek Wioletta Mędrzycka-Dąbrowska Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study Journal of Personalized Medicine ventilator-associated pneumonia bundle risk factors subglottic secretion suction continuous control pressure |
| title | Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study |
| title_full | Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study |
| title_fullStr | Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study |
| title_full_unstemmed | Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study |
| title_short | Risk Factors and Protective Factors against Ventilator-Associated Pneumonia—A Single-Center Mixed Prospective and Retrospective Cohort Study |
| title_sort | risk factors and protective factors against ventilator associated pneumonia a single center mixed prospective and retrospective cohort study |
| topic | ventilator-associated pneumonia bundle risk factors subglottic secretion suction continuous control pressure |
| url | https://www.mdpi.com/2075-4426/12/4/597 |
| work_keys_str_mv | AT jarosławpawlik riskfactorsandprotectivefactorsagainstventilatorassociatedpneumoniaasinglecentermixedprospectiveandretrospectivecohortstudy AT lucynatomaszek riskfactorsandprotectivefactorsagainstventilatorassociatedpneumoniaasinglecentermixedprospectiveandretrospectivecohortstudy AT henrykmazurek riskfactorsandprotectivefactorsagainstventilatorassociatedpneumoniaasinglecentermixedprospectiveandretrospectivecohortstudy AT wiolettamedrzyckadabrowska riskfactorsandprotectivefactorsagainstventilatorassociatedpneumoniaasinglecentermixedprospectiveandretrospectivecohortstudy |